pngtiger
| Favorite team: | LSU  |
| Location: | Mobile |
| Biography: | |
| Interests: | |
| Occupation: | |
| Number of Posts: | 1823 |
| Registered on: | 5/11/2004 |
| Online Status: | Not Online |
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re: Colonoscopies. Yes or no?
Posted by pngtiger on 4/16/25 at 9:56 pm
A few other things.
The colon and breast cancer rates in the younger population is shooting up. We are not seeing an uptick of other cancer types in this same group. For colon, the cancer we are seeing is different than run of the mill colon cancer. It’s all happening in the rectum and lower colon, different pathologically, and more aggressive. Typically, colon cancer is slow growing, which is why if you have no polyps the next one is 10 years out. This younger cancer is popping up and spreading in 1-3 years.
We have no clue what is causing it. I’d love to blame it on the COVID vaccine, as my wife (40 at diagnoses) and a friends kid (9 at diagnoses) both got the shots. More likely it is the crap in our food, plastics, hormones, etc.
Expect the age of first mammogram to drop to 35.
The colon and breast cancer rates in the younger population is shooting up. We are not seeing an uptick of other cancer types in this same group. For colon, the cancer we are seeing is different than run of the mill colon cancer. It’s all happening in the rectum and lower colon, different pathologically, and more aggressive. Typically, colon cancer is slow growing, which is why if you have no polyps the next one is 10 years out. This younger cancer is popping up and spreading in 1-3 years.
We have no clue what is causing it. I’d love to blame it on the COVID vaccine, as my wife (40 at diagnoses) and a friends kid (9 at diagnoses) both got the shots. More likely it is the crap in our food, plastics, hormones, etc.
Expect the age of first mammogram to drop to 35.
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re: Colonoscopies. Yes or no?
Posted by pngtiger on 4/16/25 at 9:43 pm
As has been mentioned, nothing is as good as a colonoscopy. The blood and stool test detect cancer. A CT of the colon detects masses. The purpose of the colonoscopy is to detect and remove BEFORE it becomes cancerous or large enough to see on CT/barium enema.
For everyone, the age to start has been changed from 50 to 45, and I expect that recommendation to drop to 40 soon. If there is a history of colon cancer in the family, age of colonoscopy should be 10 years before that person was diagnosed.
About the difference in timing for next colonoscopy after a polyp is removed: it depends on if the polyp was tubular, villous, or tubulovilllous, and also if it was sessile (flat, sometimes can’t get the whole thing) or pedunculated (has a stalk).
Lastly, that “article” you posted is quackery.
For everyone, the age to start has been changed from 50 to 45, and I expect that recommendation to drop to 40 soon. If there is a history of colon cancer in the family, age of colonoscopy should be 10 years before that person was diagnosed.
About the difference in timing for next colonoscopy after a polyp is removed: it depends on if the polyp was tubular, villous, or tubulovilllous, and also if it was sessile (flat, sometimes can’t get the whole thing) or pedunculated (has a stalk).
Lastly, that “article” you posted is quackery.
re: 76 year old Atlanta woman finds out she's 3 months pregnant.....
Posted by pngtiger on 1/14/25 at 5:39 pm
More likely she has an ovarian tumor that’s producing hCG
re: Data for you to ponder tonight: insurers are not the villain. Providers are
Posted by pngtiger on 12/12/24 at 3:15 am
quote:
Say a doctor would charge a patient $100 for a procedure and the insurer will only cover 10%. Should the doctor provide the care at $100, or should the doctor charge $1000 and get his $100 paid at 10% from the insurer?
Yeah, that’s not how it works. Medicare sets how much they pay for each CPT code. Every other insurer pays a percentage of that. Many private insurers will pay a little more, Medicaid pays a lot less.
As an example to illustrate how it works: the price they set for taking out an appendix is $1000. I can charge $1000, I can charge $1,000,000. What I get paid is a portion of that $1000, no matter what I charge.
Where I land on how big that portion is, is totally dependent on my negotiating power to get a better contract with the insurer. As a solo practitioner, there’s no negotiating, you take what they say or you don’t take that insurance. Which is partly why many doctors are becoming hospital employed.
Another reason they are becoming hospital employed is because of the amount of overhead to just chase insurers for denials, and the amount of government regulations/paperwork that make it impossible to just treat patients.
re: Is there no way to take gall stones out of the gallbladder?
Posted by pngtiger on 10/29/23 at 1:49 pm
The stones are not like kidney stones. Majority of kidney stones are calcium oxilate, which means they hold their form when grasped and respond to breaking up by ultrasound.
Gallbladder stones are like wet sand, they fall apart when grabbing them, meaning we can’t open up the GB and just pull them out. The GB also doesn’t respond well to being opened and closed with sutures, leading to bile leakage. Lastly, the stones don’t absorb the same ultrasonic waves that would break them up. And even if they do, what’s left is wet sand that will reform. That wet sand will go down through the ducts and block them, just like a full stone.
Gallbladder stones are like wet sand, they fall apart when grabbing them, meaning we can’t open up the GB and just pull them out. The GB also doesn’t respond well to being opened and closed with sutures, leading to bile leakage. Lastly, the stones don’t absorb the same ultrasonic waves that would break them up. And even if they do, what’s left is wet sand that will reform. That wet sand will go down through the ducts and block them, just like a full stone.
re: Medical professionals, is this fake blood?
Posted by pngtiger on 9/7/23 at 6:06 pm
Without commenting on the blood being thick or thin…I don’t see any laceration much less a deep laceration to the head. If the lac is in the hairline, it bleeds a lot and her hair would be full of blood and matted, like others of said.
There is very little swelling to the head/face, which would only happen if it’s right after the incident, which it is not.
Her makeup is too perfect, her lipstick is not either messed up or covered in blood. Neither Her shirt nor necklace are covered in blood despite the “bloodline” going all the way to the chest. There should be blood everywhere, so she must have changed and primped before going to the hospital.
It should be very easy to produce an X-ray showing a fractured femur, and those don’t break easy. If she does indeed have a femur fracture, she’s not changing clothes/jewelry and primping before going to the ER. She would be in a lot of pain. And the amount of pain she would have also makes me question this picture, as she would not be calm, or looking like anywhere close to a normal person.
Quals: 16 years taking care of traumas
There is very little swelling to the head/face, which would only happen if it’s right after the incident, which it is not.
Her makeup is too perfect, her lipstick is not either messed up or covered in blood. Neither Her shirt nor necklace are covered in blood despite the “bloodline” going all the way to the chest. There should be blood everywhere, so she must have changed and primped before going to the hospital.
It should be very easy to produce an X-ray showing a fractured femur, and those don’t break easy. If she does indeed have a femur fracture, she’s not changing clothes/jewelry and primping before going to the ER. She would be in a lot of pain. And the amount of pain she would have also makes me question this picture, as she would not be calm, or looking like anywhere close to a normal person.
Quals: 16 years taking care of traumas
re: Is a F150 Super Cab accommodating for a car seat?
Posted by pngtiger on 4/18/23 at 2:54 pm
I have a 2017 f150 super crew with a 6.5 bed. Back seat has more room than the Tahoe/yukon my wife drives. Have 2 car seats in there no problem. Only issue is someone sitting between then has to sit sideways.
Like others have said, 10-speed transmission is an issue. It seems to have trouble deciding on gear on slow acceleration from 35-45mph, which causes a waver. The other issue is if I jump in and go without 1-2 minute warm up, on the first big acceleration, I’ll lose power (to the wheels) for half a second.
But it’s has a ton of power, much more than the prior z71 I had, and more than a 2500 that I would use to pull trailers.
Like others have said, 10-speed transmission is an issue. It seems to have trouble deciding on gear on slow acceleration from 35-45mph, which causes a waver. The other issue is if I jump in and go without 1-2 minute warm up, on the first big acceleration, I’ll lose power (to the wheels) for half a second.
But it’s has a ton of power, much more than the prior z71 I had, and more than a 2500 that I would use to pull trailers.
re: Lumbar Laminectomy stories please.
Posted by pngtiger on 3/10/23 at 7:38 pm
A third get better
A third stay the same
A third get worse
A third stay the same
A third get worse
re: OT Docs - how do doctors determine how much of an antibiotic to prescribe?
Posted by pngtiger on 1/16/23 at 7:16 am
Lots of research by the drug company determines the correct dosing.
re: Big Three National Championships
Posted by pngtiger on 1/13/23 at 9:54 pm
Was going to say you need to check your numbers on LSU, and they also won all 3. But…the basketball cutoff is 1939, and Lsu won it in 1935.
re: Idaho Murders Thread (Links inside)
Posted by pngtiger on 1/1/23 at 8:23 pm
quote:
PS - I also feel like there is going to be another gotcha to this story.
ABC news mentioned that the biohazard crew was supposed to start cleaning the house on Friday but was turned away due to “a major break in the case.”
re: The refs created a rule to give LSU an untimed down and they still lost
Posted by pngtiger on 9/5/22 at 2:33 pm
quote:
I really do not think FSU called a timeout to challenge the play. Norvell is not that smart. They called timeout to substitute their goal line personnel
I heard the announcers say FSU had 15 players on the field, and that’s why the TO.
re: A surge in vehicle crashes is disproportionately harming lower-income families and Black..
Posted by pngtiger on 8/23/22 at 5:06 pm
I saw 2 chargers drag racing down a busy surface street during morning traffic today. Just shook my head.
A med student tried imply the premise of the article one day. I quickly corrected her. I said, “it’s not a racial issue, it’s a socioeconomic issue, and not the way you think. People are poor because of bad decision making. They lack the ability to plan ahead, they lack critical thinking, and they do not understand delayed gratification. The things that make them poor are the same reasons they get hurt more, they are more prone to risk taking behavior.”
A med student tried imply the premise of the article one day. I quickly corrected her. I said, “it’s not a racial issue, it’s a socioeconomic issue, and not the way you think. People are poor because of bad decision making. They lack the ability to plan ahead, they lack critical thinking, and they do not understand delayed gratification. The things that make them poor are the same reasons they get hurt more, they are more prone to risk taking behavior.”
re: Our Lady of the Lake Hospital in Baton Rouge officially earns Level 1 Trauma designation
Posted by pngtiger on 8/22/22 at 6:08 pm
quote:
Meh, what changed? They hit the designation on paper for as long as I can remember.
They were a level 1 according to the state. Now they are a level 1 according to the American college of surgeons, the governing body to ensure quality metrics in these institutions. It is incredibly hard to be ACS level 1 verified…my hospital/we have our visit in February, after 2 consultation visits.
re: Thyroid Cancer, how fricked?
Posted by pngtiger on 7/16/22 at 5:13 pm
Papillary and follicular are usually not bad actors. Anaplastic and medullary are very bad actors.
For papillary, treatment will depend on size of nodule, and if there is evidence of spread to nodes in your neck.
Usually, if less than 4cm and no evidence in other side or in lymph nodes, they’ll take one side out. They may end up taking both depending on those things. If they do both, you take radioactive iodide which kills any other thyroid tissue. If they leave one side, no radioactive iodide.
NCCN here’s a link to the NCCN patient handout. Good amount of information.
For us all, if we live long enough, there’s a 30% chance of developing cancer. Most commonly prostate in men and breast in women. So if you fall in that 30%, and got to chose which one to get, papillary should be close to #1 choice.
For papillary, treatment will depend on size of nodule, and if there is evidence of spread to nodes in your neck.
Usually, if less than 4cm and no evidence in other side or in lymph nodes, they’ll take one side out. They may end up taking both depending on those things. If they do both, you take radioactive iodide which kills any other thyroid tissue. If they leave one side, no radioactive iodide.
NCCN here’s a link to the NCCN patient handout. Good amount of information.
For us all, if we live long enough, there’s a 30% chance of developing cancer. Most commonly prostate in men and breast in women. So if you fall in that 30%, and got to chose which one to get, papillary should be close to #1 choice.
re: Anyone recently order a car? How long did it take for it to come in?
Posted by pngtiger on 7/9/22 at 9:02 am
Order placed October 15, still waiting. And I went to a high volume dealer.
re: Hollywood Stars Share Their Heartbreaking Abortion Stories
Posted by pngtiger on 6/28/22 at 6:49 pm
quote:
Sounds like the first one tried all the safe sex practices most americans do, and ended up pregnant anyway. I dont blame her.
I’m calling BS on this. We are supposed to believe she did both of these and got pregnant, which is a 0.02% probability (or 0.18% probability if she were taking her contraceptive incorrectly).
And the “at 2 weeks of being pregnant”, is that from finding out she was pregnant, or how the medical profession defines 2 weeks gestational age?
re: What’s the point of medical insurance?
Posted by pngtiger on 6/22/22 at 11:47 pm
ETA: just want to say, good questions/comments. I don’t completely understand this behemoth that is health insurance, but I try to learn more to help my patients navigate through the mess. You seem to be trying to understand instead of mud slinging.
I didn’t explain that well. I’m hospital based now, but when I wasn’t, I would see many uninsured patients. With many I would work something out with them.
For instance, instead of bartering, I hired a guy that did lawn care to cut my grass. I paid him, he paid off his bill to me gradually.
As to your specific question: I’ll go back to the appendix. My charge to insurance was $3000. I told those uninsured, “$1000 is what insurance would pay me. You will get a bill for the whole $3000 because I have to charge everyone equally, but what you owe me is what everyone else pays $1000. We can work out a payment plan for whatever you think you can pay me monthly. Once you hit $1000, you are paid in full in my book and I will write off the rest. I have to seek the complete payment, and you will get notices of such. After the 3rd notice I decide whether to send it to collections. At that point, the matter is dropped as i will not send it to collections.”
It’s no different than what hospitals do.
I wish there was a good way to convey my thoughts and facial expressions during my meetings with these people. I was in awe of how ignorant they were of their financials. You would think, as a business, they would know where every penny went. Luckily, new administration now that is on board with what I’m trying to do.
quote:
This feels like semantics. You said in an earlier post that you can “charge” the “normal” rate then discount it for cash payers.
I didn’t explain that well. I’m hospital based now, but when I wasn’t, I would see many uninsured patients. With many I would work something out with them.
For instance, instead of bartering, I hired a guy that did lawn care to cut my grass. I paid him, he paid off his bill to me gradually.
As to your specific question: I’ll go back to the appendix. My charge to insurance was $3000. I told those uninsured, “$1000 is what insurance would pay me. You will get a bill for the whole $3000 because I have to charge everyone equally, but what you owe me is what everyone else pays $1000. We can work out a payment plan for whatever you think you can pay me monthly. Once you hit $1000, you are paid in full in my book and I will write off the rest. I have to seek the complete payment, and you will get notices of such. After the 3rd notice I decide whether to send it to collections. At that point, the matter is dropped as i will not send it to collections.”
It’s no different than what hospitals do.
quote:
It just kind of blows my mind that these huge businesses don’t do things that are standard in every other industry.
I wish there was a good way to convey my thoughts and facial expressions during my meetings with these people. I was in awe of how ignorant they were of their financials. You would think, as a business, they would know where every penny went. Luckily, new administration now that is on board with what I’m trying to do.
re: What’s the point of medical insurance?
Posted by pngtiger on 6/22/22 at 11:24 pm
quote:
The idea that it’s impossible for a provider to know the contract rate for a procedure is not valid. That’s terrible business. Are you telling me that providers are signing contracts with insurance companies that lock the provider into an unknown price to be determined by the insurance company, subject to change without notice, that the provider can never know until after they deliver their services? I find that very hard to believe.
Yeah. It’s better to be part of a system for more bargaining power, but, for the most part insurers set the rates. If you decide to not sign the contract, it’s like alienating your customer base. You are now out of network, so you now don’t get patients from that insurer. And if you do, that patient now gets to pay more, since out of network. It sucks. It IS bad business. That’s what happens when government and big business take over.
My over-arching theme here is doctors, for the most part, want what is best for their patients, and like any other business, to be compensated fairly for services provided. Government and insurers have ruined that relationship. We are on the same side.
For your last part, I didn’t mean you specifically being given the choice, I meant the collective you. Instead of getting calls about patients being pissed off they are being charged AGAIN for a service, hospital/providers chose to bill at one time, once (hopefully) all data is known.
I would love to go to cash only. I wouldn’t have to deal with government BS, could charge what I want, could barter, could work within a patient’s financial situation, etc. it’d make things so much simpler. Unfortunately I am a surgeon, and less than 10% of what a patient is charged is directly my cost. I could chose to work for free. But, to provide my patients with the best financial situation, I take all insurances.
If you can come up with a viable option to make this whole situation better, you’d, well, idk, be rich, lauded as a hero, suicided by big insurance. Many have tried, all have failed. And every time government meddles, it only makes it worse. Reagan was an awesome president, but he’s the one that really put fire to this mess (which pushed hospitals and providers to a more business-like model).
re: What’s the point of medical insurance?
Posted by pngtiger on 6/22/22 at 10:21 pm
quote:
Slightly more difficult, sure, since it requires data on the specific plan. But not impossible. In most cases they already receive some of this information (at least coinsurance/copy), no?
It’s too difficult. There are hundreds of potential variables. I wish it were different, for everyone’s sake.
quote:
And this is where my outsider brain just breaks. In my industry, I would get crucified by my customers if I took this approach. It’s in both parties’ best interest for billing to be accurate. Why? Because as a seller, I don’t want my customer auditing/disputing invoices. It fricks up my cash flow by delaying payment, it fricks up my revenue recognition/accounting because invoices get revised, it fricks up my relationships with my customers because they don’t trust me, and it guarantees that they will audit/dispute future invoices. For my customer, it means they have to spend an inordinate amount of time ($) auditing invoices against agreements. It’s extremely inefficient and increases their overhead.
Preach! The current system is wholly, and insufferably inefficient…on purpose, to frustrate medical providers/hospitals, patients, to deny claims, to frick up revenue streams, to spend an inordinate amount of time (and money) so everyone gives up so the insurance provider wins.
My insurance covers 100% as long as I get my care at my hospital. I still get bills, and every time it takes hours over multiple days to fight the charges. They want me to say screw it, it’d be easier to just pay the damn bill.
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